Chlamydia and ectopic pregnancies

Ailsa Bernard has been pregnant at least 11 times. Seven pregnancies have ended in miscarriages, three have been ectopic and just one - so far - has resulted in a much-loved daughter, Jessica, now almost five.

Every loss has cut her to the quick, each one a potential life lost. But the difference between miscarriages and ectopic pregnancies is that ectopics are dangerous, difficult to diagnose and potentially disastrous.

According to the Ectopic Pregnancy Trust, there has been a dramatic increase in ectopic pregnancies in recent years. An estimated one in 80 pregnancies is now ectopic; 20,000 women are admitted to hospital every year for emergency, life-saving surgery after a pregnancy develops in a fallopian tube, rather than the womb, then ruptures it and causes massive internal haemorrhaging. Between five and eight women die every year either because they are unaware they are pregnant, have been misdiagnosed or have not made it to hospital in time.

Ailsa, a 35-year-old housing association worker, had her first ectopic pregnancy in 1988. She found herself doubled up in extreme pain while she was driving to work. She had to fight quite hard to get an appointment with her GP, who finally referred her to hospital where she was admitted instantly and told she needed surgery.

Unaware of the serious implications of an ectopic pregnancy, Ailsa told doctors she didn't want to be operated on. The hospital told her she had no choice - without surgery she would die. "I had not really grasped the enormity of it," she says.

Surgeons removed part of her right fallopian tube in what was a major operation. (Surgery for ectopic pregnancy often results in the loss of a fallopian tube, thus reducing fertility.) Everyone was concerned about her physical well-being, but little attention was paid to her emotional state. She left hospital with a urine infection and a terrible sense of desolation, having undergone major surgery and lost a baby.

After the operation she recalls being told "it might be a good idea" if she was checked for chlamydia, though not much more was explained. Chlamydia is a sexually transmitted infection which is dramatically on the increase; if untreated it can cause infertility and it is thought to be responsible for at least half of all ectopic pregnancies. Ailsa was given the details of the local genitourinary medicine (GUM) clinic, but she did not go. "I was only 23 at the time and I would have felt embarrassed and worried what other people's perceptions of me might be."

There were more miscarriages, then in 1992 she had just done a positive pregnancy test when she began to suffer stitch-like abdominal pains. "The pain became worse, but even more than the pain and the bleeding was this very, very strong instinct that something was not right."

She went to casualty where hospital staff thought it unlikely she had ectopic pregnancy, but agreed to carry out a laparoscopy because of her history. Ailsa was right. Her second ectopic pregnancy was lodged right at the opening of her right hand tube; surgeons removed it and again she was advised about the possible link between chlamydia and ectopic pregnancy, and to go to the GUM clinic. This time she went and she was indeed found to have chlamydia.

For Ailsa, it was a relief to have some explanation for why she was losing her pregnancies. She was given a course of antibiotics, and later re-tested to make sure the infection had cleared up. For others however, the revelation that they are suffering from a sexually-transmitted disease which may have wrecked their chances of having a baby opens a whole new area of uncertainty. How did they get it? Was it their current partner? Where did he get it?

According to Peter Greenhouse, consultant in sexual health medicine at Bristol Royal Infirmary, the number of diagnoses of chlamydia has doubled in the last five years; in the last year there has been a 20% increase in teenage women and 23% in teenage men. And, according to two pilot studies whose results will be published early in the New Year, 10% of people under 25 are infected.

"There is no doubt that chlamydia is the main preventable cause of ectopic pregnancy, but what proportion it causes is a matter of debate. It is certainly not less than 50%, and in young people it's probably over 90%.

"The best evidence comes from Sweden over the last 15 years where there's been a substantial campaign, with both education and screening, to reduce the prevalence of chlamydia. What they have found is that the ectopic rates reduced at the same rate as chlamydia."

Since chlamydia is easily and cheaply treated - a short course of antibiotics for both the woman and her partner - according to Greenhouse, the majority of ectopics are therefore easily preventable. "But people are not aware of chlamydia in this country," says Greenhouse. "It's a complete failure of public health education. The majority of people who have it do not have any obvious signs or symptoms which is why there's so much of it about.

"It's almost as though chlamydia has been biologically designed to cause ectopic pregnancies. It uses the body's immune system to create inflammation in the tubes. That damages the hairs that waft the eggs down the tube.

"The damage can take months or years. Eventually you get a tube that's burned out. Either the egg is unable to get down the tube, or it gets half way down and gets stuck, which is what causes an ectopic pregnancy.

"The stress of lost pregnancy is enormous. It's a bereavement in itself. Then there's the stress of having surgery if you have an ectopic. If, on the top of that, your gynaecologist has to broach the subject of chlamydial infection, which may not have been an old infection but an active infection, then you begin to get some idea of how tricky the whole thing is."

Almost five years ago, Ailsa and her husband Titus Bernard, 36, finally had the child they had hoped for. Jessica's birth was not without trauma - she was premature and Ailsa, after so much loss, found it hard to bond with her daughter because she was frightened she might lose her at any moment.

Then, two years ago, she went on to have yet another ectopic pregnancy - her third. While she was being monitored at her local hospital, she went into shock and her blood pressure plummeted. She was operated on to remove her fallopian tube. The ectopic pregnancy could have been caused by the tubal damage already done by her earlier chlamydia infection, no one is sure.

Ailsa's is a particularly harrowing story. Once chlamydia has done its terrible damage, there's little one can do to reverse that. But with better sex education to take the stigma out of chlamydia and a national screening programme for the infection, many women and their families might be saved the sort of heartache and health risks she endured.

• The Ectopic Pregnancy Trust can be contacted on 01895 238025.

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